Orthopedic and Trauma Department, Veteran's Memorial Teaching Hospital in Lodz, Medical University of Lodz, Lodz, Poland.
Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
Clin Orthop Surg. 2023 Oct;15(5):781-792. doi: 10.4055/cios22278. Epub 2023 Feb 13.
During pivot-shift anterior cruciate ligament (ACL) injury, bone bruises or impaction fractures of the lateral femoral condyle (LFC-IF) may occur due to impaction between the posterior part of the lateral tibial plateau and anterocentral part of the LFC. The purpose of the study was to systematically review the literature concerning the diagnosis, prevalence, clinical importance, and management of LFC-IF occurring during ACL injuries.
Included were studies concerning impaction fractures of the anterocentral part of the LFC occurring during ACL injuries. Studies concerning only bone bruises or cartilage lesions, without subchondral bone impaction, were not included. A search was performed in Medline and Scopus databases, with final search in May 2022. A secondary search was conducted within the bibliographies of included articles and using "Cited In" option. Two authors independently extracted data in three domains: study design, LFC-IF characteristics, and LFC-IF importance and management.
A total of 35 studies were included for review with several studies reporting on multiple domains. Summarily, 31 studies were on the diagnosis and prevalence, 19 studies reported on the clinical importance, and 4 studies reported on the management of LFC-IF.
A LFC-IF occurs due to the pivot-shift mechanism of ACL injury. Its radiological feature is defined as an impaction of terminal sulcus deeper than 1 mm and is present in up to 52% of patients with a torn ACL. An LFC-IF causes injury to the cartilage, probably leads to its progressive degeneration, and is significantly associated with an increased risk of a lateral meniscus injury. A large LFC-IF might be associated with greater rotational knee instability. Although several techniques of LFC-IF treatment were proposed, none of them has been evaluated on a large cohort of patients to date.
在膝关节前交叉韧带（ACL）扭伤过程中，由于外侧胫骨平台后份与外侧股骨髁前中央部之间的撞击，可能会发生外侧股骨髁骨挫伤或撞击性骨折（LFC-IF）。本研究旨在系统回顾有关 ACL 损伤过程中发生的 LFC-IF 的诊断、发生率、临床意义和处理的文献。
纳入研究包括 ACL 损伤过程中发生的外侧股骨髁前中央部撞击性骨折。仅涉及骨挫伤或软骨损伤而无软骨下骨撞击的研究不包括在内。在 Medline 和 Scopus 数据库中进行了检索，最终检索时间为 2022 年 5 月。在纳入文章的参考文献中进行了二次检索，并使用“Cited In”选项。两位作者独立提取了三个领域的数据：研究设计、LFC-IF 特征以及 LFC-IF 的重要性和处理。
共有 35 项研究纳入综述，其中多项研究报告了多个领域的内容。总的来说，31 项研究涉及诊断和发生率，19 项研究报告了临床重要性，4 项研究报告了 LFC-IF 的处理。
LFC-IF 是由于 ACL 损伤的枢轴移位机制引起的。其放射学特征定义为终沟的撞击深度超过 1 毫米，在 ACL 撕裂的患者中高达 52%存在。LFC-IF 会损伤软骨，可能导致其进行性退化，并与外侧半月板损伤的风险增加显著相关。较大的 LFC-IF 可能与更大的旋转膝关节不稳定相关。尽管提出了几种 LFC-IF 治疗技术，但迄今为止，没有一种技术在大量患者中进行过评估。
